Comparative impact of the affordable care act on breast cancer outcomes among women in two US states
IntroductionSince the implementation of the Patient Protection and Affordable Care Act (ACA) and Medicaid expansion, states that adopted the policy have seen reduced uninsured rates. However, it is unclear whether increased healthcare access, particularly for minority and socioeconomically disadvant...
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Frontiers Media S.A.
2024-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1460714/full |
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| author | Oluwasegun Akinyemi Mojisola Fasokun Terhas Weldeslase Eunice Odusanya Irene Akinyemi Kailyn Geter Meghana Akula Miriam Michael Kakra Hughes Robin Williams |
| author_facet | Oluwasegun Akinyemi Mojisola Fasokun Terhas Weldeslase Eunice Odusanya Irene Akinyemi Kailyn Geter Meghana Akula Miriam Michael Kakra Hughes Robin Williams |
| author_sort | Oluwasegun Akinyemi |
| collection | DOAJ |
| description | IntroductionSince the implementation of the Patient Protection and Affordable Care Act (ACA) and Medicaid expansion, states that adopted the policy have seen reduced uninsured rates. However, it is unclear whether increased healthcare access, particularly for minority and socioeconomically disadvantaged groups, has translated into measurable improvements in health outcomes.ObjectiveOur study aims to evaluate the impact of the ACA and Medicaid expansion on breast cancer outcomes in Louisiana, which has implemented the policy, compared to Georgia, which has not, as of 2024.MethodologyWe conducted a retrospective study using SEER registry data from January 2011 to December 2021, including women aged 18-64 diagnosed with breast cancer. The impact of the ACA and Medicaid expansion on cancer-specific survival (CSS), overall survival (OS), and stage at presentation was evaluated. The cohort was divided into pre-ACA (2011-2015) and post-ACA (2017-2021) periods, with a one-year washout (2016). A difference-in-difference (DID) approach compared outcomes between Louisiana and Georgia.ResultsThe study analyzed 62,381 women with breast cancer, with 32,220 cases in the pre-ACA period (51.7%) and 30,161 in the post-ACA period (48.3%). In Georgia, 43,279 women were included (52.3% pre-ACA vs. 47.7% post-ACA), while Louisiana had 19,102 women (50.1% pre-ACA vs. 49.9% post-ACA). Medicaid expansion in Louisiana was associated with a 0.26 percentage point reduction in overall deaths (95% CI: -10.9 to 10.4) and a 5.97 percentage point reduction in cancer-specific mortality (95% CI: -26.1 to 14.2). There was also no significant difference in disease stage at presentation compared to Georgia.ConclusionThis study found no significant differences in overall mortality, cancer-specific mortality, or disease stage at presentation among women with breast cancer in Louisiana, which implemented Medicaid expansion in 2016, compared to Georgia, which has not expanded Medicaid. |
| format | Article |
| id | doaj-art-2ad1d8a53d6d4bbdb29569896dbc9d6b |
| institution | OA Journals |
| issn | 2234-943X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-2ad1d8a53d6d4bbdb29569896dbc9d6b2025-08-20T02:12:41ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-11-011410.3389/fonc.2024.14607141460714Comparative impact of the affordable care act on breast cancer outcomes among women in two US statesOluwasegun Akinyemi0Mojisola Fasokun1Terhas Weldeslase2Eunice Odusanya3Irene Akinyemi4Kailyn Geter5Meghana Akula6Miriam Michael7Kakra Hughes8Robin Williams9College of Medicine, Howard University, Washington, DC, United StatesDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United StatesCollege of Medicine, Howard University, Washington, DC, United StatesCollege of Medicine, Howard University, Washington, DC, United StatesSchool of Nursing, Spoon River College, Canton, IL, United StatesCollege of Medicine, Howard University, Washington, DC, United StatesCollege of Medicine, Howard University, Washington, DC, United StatesCollege of Medicine, Howard University, Washington, DC, United StatesCollege of Medicine, Howard University, Washington, DC, United StatesCollege of Medicine, Howard University, Washington, DC, United StatesIntroductionSince the implementation of the Patient Protection and Affordable Care Act (ACA) and Medicaid expansion, states that adopted the policy have seen reduced uninsured rates. However, it is unclear whether increased healthcare access, particularly for minority and socioeconomically disadvantaged groups, has translated into measurable improvements in health outcomes.ObjectiveOur study aims to evaluate the impact of the ACA and Medicaid expansion on breast cancer outcomes in Louisiana, which has implemented the policy, compared to Georgia, which has not, as of 2024.MethodologyWe conducted a retrospective study using SEER registry data from January 2011 to December 2021, including women aged 18-64 diagnosed with breast cancer. The impact of the ACA and Medicaid expansion on cancer-specific survival (CSS), overall survival (OS), and stage at presentation was evaluated. The cohort was divided into pre-ACA (2011-2015) and post-ACA (2017-2021) periods, with a one-year washout (2016). A difference-in-difference (DID) approach compared outcomes between Louisiana and Georgia.ResultsThe study analyzed 62,381 women with breast cancer, with 32,220 cases in the pre-ACA period (51.7%) and 30,161 in the post-ACA period (48.3%). In Georgia, 43,279 women were included (52.3% pre-ACA vs. 47.7% post-ACA), while Louisiana had 19,102 women (50.1% pre-ACA vs. 49.9% post-ACA). Medicaid expansion in Louisiana was associated with a 0.26 percentage point reduction in overall deaths (95% CI: -10.9 to 10.4) and a 5.97 percentage point reduction in cancer-specific mortality (95% CI: -26.1 to 14.2). There was also no significant difference in disease stage at presentation compared to Georgia.ConclusionThis study found no significant differences in overall mortality, cancer-specific mortality, or disease stage at presentation among women with breast cancer in Louisiana, which implemented Medicaid expansion in 2016, compared to Georgia, which has not expanded Medicaid.https://www.frontiersin.org/articles/10.3389/fonc.2024.1460714/fullGeorgiaLouisianaaffordable care actMedicaid expansionoverall mortalitycancer-specific mortality |
| spellingShingle | Oluwasegun Akinyemi Mojisola Fasokun Terhas Weldeslase Eunice Odusanya Irene Akinyemi Kailyn Geter Meghana Akula Miriam Michael Kakra Hughes Robin Williams Comparative impact of the affordable care act on breast cancer outcomes among women in two US states Frontiers in Oncology Georgia Louisiana affordable care act Medicaid expansion overall mortality cancer-specific mortality |
| title | Comparative impact of the affordable care act on breast cancer outcomes among women in two US states |
| title_full | Comparative impact of the affordable care act on breast cancer outcomes among women in two US states |
| title_fullStr | Comparative impact of the affordable care act on breast cancer outcomes among women in two US states |
| title_full_unstemmed | Comparative impact of the affordable care act on breast cancer outcomes among women in two US states |
| title_short | Comparative impact of the affordable care act on breast cancer outcomes among women in two US states |
| title_sort | comparative impact of the affordable care act on breast cancer outcomes among women in two us states |
| topic | Georgia Louisiana affordable care act Medicaid expansion overall mortality cancer-specific mortality |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1460714/full |
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